Heart Health News

Weight-Loss Surgery Seems to Beat Diet and Exercise

TUESDAY, Oct. 22 (HealthDay News) -- For people who have a lot
of weight to lose, weight-loss surgery appears more effective than
diet and exercise, a new review suggests.

The one caveat to this study, however, is that the results only
include two years of data, so the long-term outcomes are still
unknown. This type of study, called a meta-analysis, attempts to
uncover a common thread in a number of previous studies.

"Individuals allocated to bariatric surgery lost more body weight -- on average 26 kilograms [57.3 pounds] -- compared with nonsurgical treatment, and had higher remission rates of type 2 diabetes and metabolic syndrome," said study author Viktoria Gloy, a scientist at the Basel Institute for Clinical Epidemiology and Biostatistics at University Hospital Basel in Switzerland. Metabolic syndrome is a group of symptoms that increase the risk for type 2 diabetes and heart disease.

"After surgery, patients also reported greater improvements in quality-of-life measures, and had greater reduction in medication use than nonsurgical patients," Gloy added.

Gloy and colleagues published the findings online Oct. 22 in the
BMJ.

Obesity is a significant public health risk, according to
background information in the report. The incidence of obesity has
more than doubled over the past 25 years in the United States, the
United Kingdom and in Australia. More than two-thirds of the U.S.
population is currently overweight or obese. Many European
countries aren't far behind, with overweight and obesity rates of
around 40 percent to 50 percent, according to researchers.

Obesity increases the risk of many serious ailments, including
type 2 diabetes, high blood pressure, high cholesterol,
cardiovascular disease, some types of cancer and musculoskeletal
diseases such as osteoarthritis, according to the analysis.

Treatments for obesity include weight-loss surgery and
nonsurgical options, such as changes in diet, medications, and
increasing physical activity.

To see what treatments help people lose weight and improve their
health the most, Gloy and her colleagues reviewed previously
completed studies on weight loss, and found 11 studies with nearly
800 people who'd undergone weight-loss surgery or nonsurgical
weight-loss treatments.

In addition to losing more weight, those who had weight-loss
surgery had a rate of remission of type 2 diabetes that was 22
times higher than in the group that did not get surgery. Rates of
metabolic syndrome also dropped more for those who had surgery,
according to the analysis.

Triglycerides, a type of blood fat, dropped more, and levels of
the good cholesterol (HDL) increased more for those who had
surgery.

There were no significant differences in blood pressure levels
and bad cholesterol (LDL) levels between the two groups, the
investigators found.

"The evidence beyond two years of follow-up, in particular adverse events, cardiovascular diseases and mortality, remains unclear and calls for further research on the topic," noted Gloy.

Dr. Joel Zonszein, director of the clinical diabetes center at
Montefiore Medical Center in New York City, said: "Weight gain is
very easy, but to lose weight is very difficult. This was a careful
meta-analysis, and I agree with what they've found. We don't yet
understand exactly how bariatric surgeries cause remission of type
2 diabetes," he pointed out.

Another expert said weight-loss surgery should be happening more
often.

"Bariatric surgery is underutilized. If we were talking about any other treatment with such a striking effect on diabetes, it would be offered to patients sooner," said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City.

Of course, like any surgery, weight-loss surgeries don't come
without risk. The most common complications reported in the current
analysis were iron deficiency anemia and the need for re-operation.
The surgery is also expensive. The U.S. National Institute of
Diabetes and Digestive and Kidney Diseases estimates that
weight-loss surgery averages as much as $25,000.

Roslin and Zonszein both said that people undergoing weight-loss
surgery need to be carefully chosen. Current recommendations
recommend the surgery for anyone with a body mass index (BMI) above
40, or a BMI of 35 or higher if they have other conditions related
to obesity, such as type 2 diabetes or high blood pressure. BMI is
a measurement based on height and weight.

But, both experts felt that more people should be included in
those recommendations. Zonszein said people with BMIs as low as 30,
if they had evidence of other metabolic abnormalities, should be
counseled on the surgery. Roslin also said that if people with type
2 diabetes can't maintain control on oral medications that they
should be offered a surgical option.

Roslin said that people with type 2 diabetes should try to lose
weight and exercise more first. "Give yourself a chance to make
lifestyle changes. But, it's very hard to lose 5 percent of your
body weight. If you don't think you'll be able to do it, then you
owe it to yourself to learn about surgical options," he
suggested.

"There are real risks with surgery that shouldn't be underestimated, but there are real risks from diabetes, too," Roslin noted. "Let's say we were talking about colon cancer instead of diabetes, and I said, 'There's a treatment that could reduce your risk by 22 times, but it's invasive, would you consider it?'"

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.